50岁以上病理性乳头溢液162例诊疗分析

An analysis of diagnosis and treatment of 162 cases over 50 years old with pathological nipple discharge

目的 分析50岁以上病理性乳头溢液患者的影像学、病理学检查及肿瘤指标检测结果。方法 回顾性分析162例50岁以上病理性乳头溢液患者的临床资料,包括患者外周血癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、CA15-3、CA125和CA72-4含量,患者均行乳腺超声、钼靶、核磁共振以及病理学检查,分析乳头溢液合并乳房肿块与病理诊断的关系。结果 乳腺超声对血性、浆液性和水样溢液的阳性检出率均高于乳腺钼靶(75.0%vs. 12.5%、41.1%vs. 4.4%和25.0%vs. 16.7%)(P<0.01)。162例患者中,仅3例出现CA72-4含量升高。石蜡病理结果证实25例为乳腺癌患者。血性溢液患者的乳腺癌发生率高于浆液性和水样溢液患者(35.4%vs. 6.7%和8.3%)(P<0.01)。乳头溢液合并乳房肿块患者的乳腺癌发生率高于未合并乳房肿块患者(31.3%vs. 11.5%)(P<0.05)。结论 50岁以上血性乳头溢液或乳头溢液合并乳房肿块患者的乳腺癌发生率较高,完善影像学检查可提高病理性乳头溢液的诊断准确率。

Objective To analyze the imaging and pathological examinations and tumor marker detection in the patients over 50 years old with pathological nipple discharge.Methods The clinical data of 162 patients over 50 years old with pathological nipple discharge were retrospectively analyzed, which included serum levels of CEA,CA19-9,CA15-3,CA125 and CA72-4 in peripheral blood. The examinations of breast ultrasound, molybdenum target, magnetic resonance imaging and pathology were carried out.The relationship of nipple discharge with breast lump and pathological diagnosis was analyzed.Results The positive rates of bloody, serous and watery nipple discharge detected by breast ultrasound were higher than those by molybdenum target(75.0% vs. 12.5%,41.1% vs. 4.4% and 25.0% vs. 16.7%)(P<0.01).Of 162 cases, the content of CA72-4 was increased only in 3 cases.The paraffin pathology confirmed that there was 25 cases with breast cancer. The incidence of breast cancer in the patients with bloody nipple discharge was higher than that in those with serous and watery nipple discharge(35.4% vs. 6.7% and 8.3%)(P<0.01).Moreover, the incidence of breast cancer in the patients with nipple discharge combined with breast lump was higher than that in those without breast lump(31.3% vs. 11.5%)(P<0.05).Conclusion The higher incidence of breast cancer is found in the patients over 50 years old with bloody nipple discharge or nipple discharge combined with breast lump.The improvement of imaging examination could enhance the accuracy rate of diagnosis in the patients with pathological nipple discharge.